Eastern Cardiothoracic Surgical Society

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Uniportal VATS Lobectomy and Decortication: Not An Everyday Occurrence
Joshua S. Newman, Alexandra S. Renzi, Lawrence Glassman, Paul C. Lee, Julissa Jurado, Kevin Hyman, David Zeltsman.
Northwell Health, New Hyde Park, NY, USA.

Background:
Management of trapped lung, right lower lobe mass and hydropneumothorax through Uniportal Video Assisted Thoracoscopic Surgery (VATS) is controversial. The goals of this approach is to control the pleural space at the time of curative resection.
Methods:
A single 2cm incision between the posterior and mid axillary lines in the 7th intercostal space is the preferred access to the chest for Uniportal VATS. It was obvious that full lung decortication was necessary to proceed with right lower lobectomy as planned. An anatomic VATS lobectomy was performed without incident. No indications for mediastinal lymph node dissection were present. The lung re-expanded and filled the thoracic cavity well. A single 20Fr chest tube was inserted through the existing VATS incision. The patient was extubated on the table and transferred to the recovery room in stable condition.
Results:
Postoperatively, the patient recovered well with minimal air leak that resolved on postoperative day 5. Discharge was delayed to allow multiple consultants to complete his workup for lymphocyte variant hypereosinophilia with eventual discharge on postoperative day 7.
Final pathology revealed the presence of an aspergilloma in the right lower lobe and aspergilla was cultured from the decortication specimen thus making the diagnosis of aspergillus empyema.
Conclusions:
Uniportal VATS is a most minimally invasive approach to a complex intrathoracic pathology, including complicated inflammatory/infectious conditions like aspergilloma / aspergillus empyema. Lobectomy can be performed safely and efficiently, even when decortication may be necessary, through this approach.


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